The impact of prior prolapse repairs on surgical outcomes with minimally invasive sacral colpopexy
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ORIGINAL ARTICLE
The impact of prior prolapse repairs on surgical outcomes with minimally invasive sacral colpopexy Alexandra Dubinskaya 1 & Megan S. Bradley 2 & Dorothy B. Wakefield 1,3 & Jonathan P. Shepherd 1 Received: 22 October 2019 / Accepted: 4 February 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis To determine whether prior prolapse repair has an impact on operative time, surgical complications, and prolapse recurrence with minimally invasive sacral colpopexy (MISC). Methods This was a retrospective study of all laparoscopic and robotic MISC procedures performed from January 2009 to July 2014 at the University of Pittsburgh Medical Center. Patient demographics, clinical and surgical data were compared in women who underwent MISC for initial repair versus those undergoing MISC for recurrence after prior prolapse surgery. Our primary outcome was operating room (OR) time (skin incision to closure) using linear regression. Logistic regression compared complications (a composite variable considered present if any major complication occurred) and prolapse recurrence (any POP-Q point ≥0 or retreatment). Results Of 816 subjects, the mean age was 59.6 ± 8.7, with mean BMI 27.0 ± 3.0 in a primarily Caucasian population (97.8%). Subjects had predominantly POP-Q stage III prolapse (69.9%), and 21.3% reported prior prolapse repair. OR time was 205.0 ± 69.0 min. Prior prolapse repair did not impact OR time (p = 0.25) after adjusting for age, concomitant procedures, POP-Q measurements, changes in OR personnel, case order in the day, and preoperative stress incontinence. Complications occurred in 15.8% but were not impacted by prior prolapse repair (OR = 0.94, 95% CI = 0.53–1.67) after adjusting for potential confounders. During a median follow-up of 31 weeks, 7.8% had recurrence with no impact from prior prolapse surgery (OR = 1.557, 95% CI = 0.67–3.64) after adjusting for potential confounders. Conclusions We were unable to demonstrate increased OR time, complications, or prolapse recurrence for MISC based on history of prior prolapse repair. Longer follow-up is needed to confirm the lack of difference in prolapse recurrence rates. Keywords Minimally invasive surgery . Sacrocolpopexy . Intraoperative complications . Vaginal prolapse . Vaginal prolapse recurrence . Recurrent prolapse
Introduction Pelvic organ prolapse (POP) is a common problem that is often managed surgically, with over 300,000 surgical procedures performed annually in the USA. The lifetime risk of having surgery for either POP or urinary incontinence up to age 80 is 11.1% [1]. There have been many surgical
* Jonathan P. Shepherd [email protected] 1
Trinity Health of New England, Hartford, CT, USA
2
University of Pittsburgh Medical Center—Magee-Women’s Hospital, Pittsburgh, PA, USA
3
University of Connecticut, Hartford, CT, USA
approaches introduced to correct apical prolapse. However, abdominal sacrocolpopexy is often considered the most durable operation for advanced POP and serves as t
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